medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2012, Number 6

<< Back Next >>

Acta Ortop Mex 2012; 26 (6)

Bone healing after surgery for seudarthrosis of the carpal scaphoid

Ezquerra-Herrando L, Corella-Abenia E, Castillo-Palacios A, Blanco-Rubio N, Albareda-Albareda J

Language: Spanish
References: 19
Page: 354-357
PDF size: 73.97 Kb.


ABSTRACT

Introduction: The controversy around the treatment of carpal scaphoid pseudoarthrosis has an important place in traumatology. The purpose of this paper is to compare bone healing after surgery for carpal scaphoid pseudarthrosis. Material and methods: This is a retrospective study of the 50 cases of carpal scaphoid pseudarthrosis treated from 1992 to 2010. Data on sex, age, involved side, and smoking were collected. Pseudarthrosis was typified according to the Herbert and Fisher classification. We considered the surgical technique used, the time elapsed between the initial trauma and surgery, the presence or absence of healing, and the postoperative healing time and complications. Results: The sample included 49 males (98%) and one female (2%). According to Herbert and Fisher, 45 patients (90%) had D1 pseudarthrosis and 5 patients (10%) had D2 pseudarthrosis. Mean time between the fracture and surgery was 30 months (2-345). The surgical technique used was percutaneous without opening and curettage of the pseudarthrosis focus in 8 patients (16%), curettage and osteosynthesis screw in 7 patients (14%), and curettage, graft and internal fixation with Kirschner nails or screws in the remaining 34 patients (70%). Thirty-four patients (68%) achieved bone healing. Conclusions: The delayed diagnosis and treatment of scaphoid pseudarthrosis is the most important prognostic factor affecting surgical success (p ‹ 0.001).


REFERENCES

  1. Herbert TJ, Fisher WE: Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br 1984; 66: 114-23.

  2. Szabo RM, Manske D: Displaced fractures of the scaphoid. Clin Orthop 1988; 230: 30-8.

  3. Mack GR, Bosee MJ, Gelbermann RH, Yu E: The natural history of scaphoid nonunion. J Bone Joint Surg Am 1984; 66: 504-6.

  4. Herbert TJ: The fractured scaphoid. St. Louis, MO: Quality Medical Publishing; 1990: 31.

  5. Barton NJ: Experience with scaphoid grafting. J Hand Surg Br 1997; 22 (2): 153-60.

  6. Schuind F, Haentjens P, Van Innis F, Vander C, García-Elías M, Senwald G: Prognostic factors in the treatment of carpal scaphoid nonunions. J Hand Surg Am 1999; 24 (4): 761-76.

  7. Huang Y, Liu Y, Chen T: Long-term results of scaphoid nonunion treated by intercalated bone grafting and Herbert’s screw fixation – a study of 49 patients for at least five years. Int Orthop 2009; 33: 1295-300.

  8. Henry M: Collapsed scaphoid non-union with dorsal intercalated segment instability and avascular necrosis treated by vascularized wedge-shaped bone graft and fixation. J Hand Surg 2007; 32E: 2: 148-54.

  9. Little CP, Burston BJ, Hopkinson-Woolley J, Burge P: Failure of surgery for scaphoid non-union is associated with smoking. J Hand Surg 2006; 31B: 6: 252-5.

  10. Shin AY, Chang M, Moran SL, Steinmann SP, Bishop AT: Outcomes and complications of 1,2-intercompartmental supraretinacular arterial vascularized bone grafting of scaphoid nonunions. En: 95th Annual Meeting of the American Society for Surgery of the Hand. New York; 2004.

  11. Osterman AL: Vascularized bone grafting. Does it make a difference? Current concepts: master techniques in hand surgery. Boston: American Society for Surgery of the Hand; 1999.

  12. Jupiter JB, Shin AY, Trumble TE, Fernandez DL: Traumatic and reconstructive problems of the scaphoid. Instr Course Lect 2001; 50: 105-22.

  13. Shah J, Jones WA: Factors affecting the outcome in 50 cases of scaphoid nonunion treated with Herbert screw fixation. J Hand Surg 1998: 23B: 5: 680-5.

  14. Christodoulou LS, Kitsis CK: Internal fixation of scaphoid non-union: a comparative study of three methods. Injury 2001; 32 (8): 625-30.

  15. Warren-Smith CD, Barton NJ: Non-union of the scaphoid: Rüsse graft vs Herbert screws. J Hand Surg Br 1988; 13 (1): 83-6.

  16. Filan SL, Herbert TJ: Herbert screw fixation of scaphoid fractures. J Bone Joint Surg Br 1996; 78 (4): 530-4.

  17. Merrell GA, Wolfe SW, Slade 3rd JF: Treatment of scaphoid non-unions: quantitative meta-analysis of the literature. J Hand Surg 2002; 27A: 685-91.

  18. Nakamura R, Horii E, Watanabe K, Tsunoda K, Miura T: Scaphoid non-union: factors affecting the functional outcomes of open reduction and wedge grafting with Herbert screw fixation. J Hand Surg 1993; 18B: 219-24.

  19. Radford PJ, Matthewson MH, Meggitt BF: Herbert screw for delayed and non-union of scaphoid fractures: a review of fifty cases. J Hand Surg 1990; 15B: 455-9.




2020     |     www.medigraphic.com